What is vaginitis?
"Vaginitis" is a word that is used to describe disorders that cause infection or inflammation ("itis" means inflammation) of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from an infection caused by organisms such as bacteria, yeast, or viruses, as well as by irritations from chemicals in creams, sprays, or even clothing that are in contact with this area. In some cases, vaginitis results from organisms that are passed between sexual partners.

How do I know if I have vaginitis?
The common symptoms of vaginitis are itching, burning, and vaginal discharge that is different from your normal secretions. *-The itching and burning can be inside the vagina or on the skin or vulva just outside the vagina. Discomfort during urination or sexual intercourse may also occur. If everyone with vaginitis had these symptoms, then the diagnosis would be fairly simple. However, it is important to realize that as many as 4 out of every 10 women with vaginitis may not have these typical symptoms. Frequently, a routine gynecologic exam will confirm vaginitis even if symptoms are not present. This is one reason why it is important to have a gynecologic exam at least every 2 years.

Is vaginal discharge normal?
A women's vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and odor-free. During the normal menstrual cycle the amount and consistency of discharge vary. At one time of the month there may be a small amount of a very thin or watery discharge and at another time, a more extensive thicker discharge may appear. All of these descriptions could be considered normal.

A vaginal discharge that has an odor or that is irritating is usually an abnormal discharge. The irritation might be itching or burning or both. The burning could feel like a bladder infection. *-The itching may be present at any time of the day but it is often most bothersome at night. Both of these symptoms are usually made worse by sexual intercourse. It is important to see a doctor or clinician if there has been a change in the amount, appearance, or smell of the discharge.

What are the most common types of vaginitis?
The six most common types of vaginitis are:

Candida or "yeast" vaginitis

Bacterial vaginosis

Trichomoniasis vaginitis

Chlamydia vaginitis

Viral vaginitis

Noninfectious vaginitis

Although each of these causes of vaginal infection can have different symptoms, it is not always easy for a patient to figure out which type of vaginitis she has; in fact, diagnosis can even be tricky for an experienced clinician. Part of the problem is that sometimes more than one type of vaginitis can be present at the same time. Often vaginitis is present without any symptoms at all.

To help you better understand these six major causes of vaginitis, let's look briefly at each one of them and how they are treated.

What are Candida or "yeast" infections?
Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." They are caused by one of the many species of fungus called Candida. Candida normally live in small numbers in the vagina as well as in the mouth and digestive tract of both men and women.

Yeast infections produce a thick, white vaginal discharge with the consistency of cottage cheese. Although the discharge can be somewhat watery, it is odorless.
*-Yeast infections usually cause the vagina and the vulva to be very itchy and red.

Since yeast is normal in a women's vagina, what makes it cause an infection? Usually this happens when a change in the delicate balance in a woman's system occurs. *-For example, a woman may take an antibiotic to treat a urinary tract infection and the antibiotic kills her "friendly" bacteria that normally keep the yeast in balance; as a result the yeast overgrows and causes the infection. Other factors which can upset the delicate balance include pregnancy which changes hormone levels and diabetes which allows too much sugar in the urine and vagina.

Risk Factors for Vaginal Candida Infections

Recent Course of Antibiotics

Uncontrolled Diabetes

Pregnancy

High Estrogen Contraceptives

Immunosuppression

Thyroid or Endocrine Disorders

Corticosteroid Therapy

What is bacterial vaginosis?
Although "yeast" is the name most women know, bacterial vaginosis is actually the most common vaginal infection in women of reproductive age. Bacterial vaginosis will often cause a vaginal discharge. The discharge is usually thin and milky and is described as having a "fishy" odor. *-This odor may become more noticeable after intercourse. Redness or itching of the vagina are not common symptoms of bacterial vaginosis. It is important to note that many women with bacterial vaginosis have no symptoms at all and the vaginitis is only discovered during a routine gynecologic exam. Bacterial vaginosis is caused by a combination of several bacteria. These bacteria seem to overgrow much the same way as Candida will when the vaginal balance is upset. The exact reason for this overgrowth is not known. Since bacterial vaginosis is caused by bacteria, not by yeast, it is easy to see that different methods are needed to treat the different infections. A medicine that is appropriate for yeast is not effective against the bacteria that causes bacterial vaginosis.

What are trichomoniasis, chlamydia, and viral vaginitis?
Trichomonias, commonly called "trite" (pronounced "trick"), is caused by a tiny single-celled organism known as a "protozoa." When this organism infects the vagina is can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms. It is important to understand that this type of vaginitis can be transmitted through sexual intercourse. For treatment to be effective, the sexual partner must be treated at the same time as the patient.

Another primarily sexually transmitted form of vaginitis is caused by the germ known as Chlamydia. Unfortunately, most women do not have symptoms. This makes diagnosis difficult. A vaginal discharge is sometimes present with this infection but not always. More often a woman might experience light bleeding especially after intercourse. She may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. If you fit this description, you should request screening for Chlamydia during your annual checkup. The best "treatment" for Chlamydia is prevention. Use of a condom will decrease your risk of contracting not only Chlamydia, but other sexually transmitted diseases as well.

Many of the germs that cause vaginitis can be spread between men and women during sexual intercourse. Use of a barrier contraceptive such as a condom can help reduce your risk of contracting these and more serious germs such as the human immunodeficiency virus (HIV) which can lead to aids.

Viruses are a common cause of vaginitis. One form caused by the herpes simplex virus (HSV) is often just called "herpes" infection. These infections are also spread by sexual intimacy. The primary symptom of herpes vaginitis is pain associated with lesions or "sores." These sores are usually visible on the vulva or the vagina but occasionally are inside the vagina and can only be seen during a gynecologic exam. Outbreaks of HSV are often associated with stress or emotional upheaval.

Another source of viral vaginal infection is the human papillomavirus (HPV). HPV can also be transmitted by sexual intercourse. *-This virus can cause painful warts to grow in the vagina, rectum, vulva, or groin. These warts are usually white to gray in color, but they may be pink or purple. However, visible warts are not always present and the virus may only be detected when a Pap smear is abnormal.

What is noninfectious vaginitis?
Occasionally, a woman can have itching, burning, and even a vaginal discharge without having an infection. The most common cause is an allergic reaction or irritation from vaginal sprays, douches, or spermicidal products. The skin around the vagina can also be sensitive to perfumed soaps, detergents, and fabric softeners.

Another noninfectious form of vaginitis results from a decrease in hormones because of menopause or because of surgery that removes the ovaries. In this form, the vagina becomes dry or "atrophic." The woman may notice pain, especially with sexual intercourse, as well as vaginal itching and burning.

How do you treat vaginitis?
The key to proper treatment of vaginitis is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your health care practitioner by paying close attention to exactly which symptoms you have and when they occur, along with a description of the color, consistency, amount, and smell of any abnormal discharge. Do not douche before your office or clinic visit; it will make accurate testing difficult or impossible.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. *-When a woman has had a yeast infection diagnosed by her doctor, she is usually treated with a prescription for a vaginal cream or suppositories. If the infection clears up for some period of time but then the exact same symptoms occur again, a woman can obtain, with her doctor or pharmacist's advice, a vaginal cream or suppository without a prescription that can completely treat the infection. The important thing to understand is that this medication may only cure the most common types of Candida associated with vaginal yeast infections and will not cure other yeast infections or any other type of vaginitis. If you are not absolutely sure, see your doctor. You may save the expense of buying the wrong medication and avoid delay in treating your type of vaginitis.

When obtaining these over-the-counter medicines, be sure to read all of the instructions completely before using the product. Be sure to use all of the medicine and don't stop just because your symptoms have gone away.

Be sure to see your health care practitioner if:

All of the symptoms do not go away completely.

The symptoms return immediately or shortly after you finish treatment.

You have any other serious medical problems such as diabetes.

You might be pregnant.

Other forms of infectious vaginitis are caused by organisms that need to be treated with oral medication and/or a vaginal cream prescribed by your doctor. Products available without a prescription will probably not be effective. As with all medicine, it is important to follow your doctor's instructions as well as the instructions that come with the medication. Do not stop taking the medicine when your symptoms go away. Do not stop taking the medicine when your symptoms go away. Do not be embarrassed to ask your doctor or health care practitioner questions. Good questions to ask include: It is okay to douche while on this vaginal cream? Should you abstain from sexual intercourse during treatment? Should your sexual partner(s) be treated at the same time? Will the medication for this vaginitis agree with your other medication(s)? Should you continue the vaginal cream or suppositories during your period? Do you need to be reexamined and if so, when?"Noninfectious" vaginitis is treated by changing the probable cause. If you have recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the new product to see if the symptoms remain. The same instruction would apply to a new vaginal spray, douche, sanitary napkin, or tampon. If the vaginitis is due to hormonal changes, estrogen may be prescribed to help reduce symptoms.

How can I prevent vaginitis?
There are certain things that you can do to decrease the chance of getting vaginitis. If you suffer from yeast infections, it is usually helpful to avoid garments that hold in heat and moisture. The wearing of nylon panties, pantyhose without a cotton panel, and tight jeans can lead to yeast infections. Good hygiene is also important. Many doctors have found that if a woman eats yogurt that contains active cultures (read the label) she will get fewer infections.

Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, repeated douching may cause irritation or, more importantly, may hide a vaginal infection.

Safe sexual practices can help prevent the passing of diseases between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed, or have low levels of estrogen for any reason, discuss with your doctor the use of hormone pills or creams to keep the vagina lubricated and healthy.

Summary

"Vaginitis" is a medical term that describes an infection or irritation of the vagina and/or vulva by yeast, bacteria, viruses, other organisms, or chemical irritants.

When present, symptoms of different types of vaginitis overlap which can make diagnosis difficult. In addition, more than one cause of vaginitis can be present at the same time in the same woman.

Good health habits are important! Have a complete gynecologic exam, including a pap smear at least every 2 years. If you have multiple sexual partners, you should request screening for sexually transmitted diseases.

Proper diagnosis by your doctor or health care practitioner is the key to proper treatment. Yeast, bacteria, viruses, and other organisms each require a specific type of therapy. Use of the wrong medication will not help and will only delay proper treatment.

All vaginitis is not caused by yeast. The use of a nonprescription medication or other treatment may make the proper diagnosis more difficult if yeast is not the cause of the infection.

Some forms of vaginitis are sexually transmitted and can co-exist with other more serious sexually transmitted diseases. The proper use of condoms can be helpful in preventing some forms of vaginitis.

Follow complete instructions in treating your vaginal infection. If symptoms do not clear completely or if they reoccur, see your doctor or health care practitioner for further instructions.

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